Logan Steele
Eye muscle weakness, or ophthalmoplegia, can be caused by a variety of factors, including congenital conditions, genetic mutations, and underlying health issues. It can also be caused by increased screen time, leading to strained eye muscles and fatigue. Ophthalmoplegia is the paralysis or weakness of one or more of the six muscles that control eye movement and hold the eye in place. It can be further classified into chronic progressive external ophthalmoplegia and internal ophthalmoplegia, with the former typically appearing in adults between 18 and 40 and the latter caused by nerve damage leading to double vision. External ophthalmoplegia is often caused by muscle disorders or mitochondrial diseases, while internal ophthalmoplegia results from multiple sclerosis, trauma, or infarction. Myasthenia gravis is another condition that affects eye muscles, interfering with nerve-muscle communication and causing muscle weakness that worsens throughout the day.
| Characteristics | Values |
|---|---|
| Medical condition | Ophthalmoplegia, Myasthenia Gravis, Computer Vision Syndrome, Digital Eye Strain |
| Symptoms | Double vision, drooping eyelids, blurred vision, watery eyes, light sensitivity, pain between the eyes and forehead, burning eyes, eye strain, headaches, difficulty swallowing, general muscle weakness, trouble focusing, trouble speaking, slurred speech, difficulty eating, severe breathing difficulties, difficulty standing, difficulty lifting objects, difficulty walking, progressive supranuclear palsy (PSP) |
| Causes | Genetic and mitochondrial diseases, genetic syndromes, a history of vascular disease or stroke, nerve damage, trauma, multiple sclerosis, infarction, Graves' disease, Kearns-Sayre syndrome, diabetes, excessive screen time, lack of blinking |
| Treatment | Special glasses, eye patch, treatment for migraines, medication (pyridostigmine, glycopyrrolate, corticosteroids), surgery, botulinum toxin injections, teprotumumab, prisms in glasses, occlusion foils, blinking and yawning, adequate sleep |
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What You'll Learn
Myasthenia gravis
Ocular myasthenia gravis affects only the muscles that move the eyes and eyelids. Symptoms include double vision, trouble focusing, and drooping eyelids. The brain controls the eye muscles to keep the eyes aligned properly. Weakness of the eye muscles leads to misalignment, causing double vision. For about half of patients with myasthenia gravis, the first symptoms are visual. About 15% of these patients will continue to only experience visual symptoms, even years after their diagnosis. In the remaining 85% of patients, symptoms of weakness will develop in another part of the body, usually within three years. At this point, patients are diagnosed with generalized myasthenia gravis.
Generalized myasthenia gravis affects muscles throughout the body. In addition to visual symptoms, it may cause trouble speaking, swallowing, and weakness in the arms or legs. The amount of muscle weakness typically fluctuates and may be more noticeable at the end of the day.
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Ophthalmoplegia
There are two types of ophthalmoplegia: chronic progressive external ophthalmoplegia and internal ophthalmoplegia. Chronic progressive external ophthalmoplegia typically appears in adults between the ages of 18 and 40 years. It usually begins with drooping eyelids and difficulty controlling the muscles that coordinate the eyes. External ophthalmoplegia is usually caused by muscle disorders or mitochondrial diseases such as Graves' disease or Kearns-Sayre syndrome.
Internal ophthalmoplegia, also known as internuclear ophthalmoplegia, is caused by nerve damage to the nerve fibres that coordinate lateral eye movement. This leads to double vision. This type of ophthalmoplegia is often caused by multiple sclerosis, trauma, infarction, or infections like Lyme disease, HIV, and herpes zoster. It can also be caused by certain autoimmune diseases such as lupus and Sjögren's syndrome.
It is important to note that ophthalmoplegia is different from myasthenia gravis, a condition where the body's immune system interferes with the muscles' receptors for acetylcholine, causing muscle fatigue and weakness. Ocular myasthenia gravis specifically affects the muscles that move the eyes and eyelids, resulting in double vision, trouble focusing, and drooping eyelids. While there are medications to treat myasthenia gravis, they may have side effects, and long-term steroid use can lead to osteoporosis, diabetes, high blood pressure, sleep disturbances, and emotional changes.
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Digital eye strain
Prolonged use of digital devices such as computers, tablets, e-readers, and cell phones can cause digital eye strain, a group of eye and vision-related problems. This is because the eyes work harder when viewing a digital screen compared to reading printed text. The letters on a screen are often not as sharply defined, the level of contrast is reduced, and glare and reflections may be present, making viewing difficult.
The symptoms of digital eye strain include itching, tearing, dryness, redness, and discomfort. You may also experience blurred vision, double vision, and headaches. The eyes may feel tired and you may have trouble focusing. In addition, you may experience neck and shoulder pain due to poor alignment and posture when using digital devices.
The risk of digital eye strain increases with the amount of screen time. The average American worker spends seven hours a day on the computer, and the pandemic has further increased screen time for many individuals. To alleviate digital eye strain, it is recommended to follow the 20-20-20 rule: for every 20 minutes spent looking at a screen, look away for 20 seconds at an object 20 feet away. Other recommendations include reducing daily screen time, improving lighting, minimizing glare, taking regular breaks, and blinking frequently.
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Vascular disease
Ophthalmoplegia, or weakness of the eye muscles, can be caused by a history of vascular disease or stroke. Ophthalmoplegia is the paralysis or weakness of the eye muscles. It can affect one or more of the six muscles that hold the eye in place and control its movement.
Vascular dysregulation, or the improper regulation of blood flow, can also lead to ophthalmoplegia. This can be further classified into primary vascular dysregulation (PVD) and secondary vascular dysregulation. In PVD, the blood-brain and blood-retinal barriers are weaker, and retinal venous pressure is increased. This can lead to optic nerve compartment syndrome, retinal artery and vein occlusions, and anterior ischemic neuropathy.
Additionally, arteriosclerosis, or degenerative changes in the walls of arteries, can lead to thickening and narrowing of the blood vessels, resulting in reduced blood flow to the eye and potentially causing vision loss. Vascular hypertension, or raised blood pressure, is often associated with arteriosclerosis and can impact the health of the eye.
Furthermore, diabetic patients with advanced retinal disease are at an increased risk of peripheral vascular disease, which can affect the eyes. Diabetic retinopathy can cause abnormal blood vessel growth in the retina and sometimes the iris, leading to vision loss.
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Mitochondrial diseases
Primary mitochondrial diseases are caused by direct impairments of mitochondrial functions due to mutations in either mitochondrial DNA (mtDNA) or nuclear DNA (nDNA). These mutations can affect the optic nerve, retina, extraocular muscles, and eyelids. Ophthalmoplegia, or paralysis/weakness of the eye muscles, is a common manifestation of mitochondrial disease. It can cause drooping eyelids, double vision, and difficulty controlling eye movements. Chronic progressive external ophthalmoplegia typically appears in adults between the ages of 18 and 40, while internal ophthalmoplegia is caused by nerve damage leading to lateral eye movement issues and double vision.
Mitochondrial dysfunction can also contribute to age-related ophthalmologic diseases such as diabetic retinopathy, AMD, and glaucoma. Genetic disorders due to mitochondrial dysfunction are not uncommon, and often result in eye-related issues, including visual loss from optic nerve and retinal disease, visual field loss, and ocular dysmotility.
Recent studies have revealed a minimum prevalence of approximately 1 in 4,300 individuals with mitochondrial disease in the North East of England, making it one of the most common adult-onset inherited neurological diseases. Mitochondrial diseases can be inherited maternally or follow Mendelian genetics if the disrupted genes are chromosomal.
With the advancement of genetic testing, it has become evident that genotype-phenotype correlations in mitochondrial diseases are complex and imprecise. Classic presentations of primary mitochondrial diseases typically affect the extraocular muscles, retina, optic nerve, and cerebral cortex/white matter. Treatments for ophthalmoplegia depend on the type, symptoms, and underlying cause. While there is no cure for mitochondrial disease, emerging therapies such as antioxidant and gene therapy approaches show promise in treating ophthalmologic manifestations.
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Frequently asked questions
Ophthalmoplegia is the paralysis or weakness of the eye muscles. It can affect one or more of the six muscles that hold the eye in place and control its movement.
Some symptoms of ophthalmoplegia include double or blurred vision, drooping eyelids, and an inability to position the eyes in sync.
Ophthalmoplegia is generally caused by a disruption of the messages sent from the brain to the eyes. It can be congenital (present at birth) or develop later in life.
Treatment for ophthalmoplegia depends on the type, symptoms, and underlying cause. Adults can be fitted for special glasses or wear an eye patch to relieve double vision and achieve normal vision.
Myasthenia gravis is a condition that causes weakness of specific muscles in the body. It affects how nerves communicate with muscles, leading to muscle weakness that worsens throughout the day and with activity.
